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Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis

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Abstract

Background

This study aimed to compare the efficacy and safety of laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (LC-IntraERCP) and laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC-LCBDE) to determine which one-stage therapeutic strategy provides better outcomes for patients with gallstones and common bile duct stones.

Methods

Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched to identify eligible articles from the database inception to September 2020. The revised Cochrane risk of bias tools for randomized trials (RoB-2) and non-randomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. The primary outcomes consisted of surgical success, retained stones, and overall postoperative complications, while secondary outcomes included postoperative bleeding, postoperative pancreatitis, postoperative bile leakage, conversion to laparotomy, and operative time.

Results

Eight studies (four RCTs and four Non-RCTs with high quality) with 2948 patients were included. No significant difference was seen between the two groups regarding surgical success, overall postoperative complications, conversion to laparotomy, and operative time. The meta-analysis demonstrated that in the LC-IntraERCP group, the rate of retained stones (OR 0.51, 95% CI 0.28–0.91) and postoperative bile leakage were lower (OR 0.25, 95% CI 0.09–0.69), while in the LC-LCBDE group, postoperative bleeding (OR 5.24, 95% CI 1.65–16.65) and postoperative pancreatitis (OR 4.80, 95% CI 2.35–9.78) decreased.

Conclusions

LC-IntraERCP and LC-LCBDE exhibited similar efficacies when surgical success rate, overall postoperative complications, conversion to laparotomy, and operative time were compared. However, LC-IntraERCP is probably to be more effective in terms of lowering the rate of retained stones.

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Acknowledgements

The authors would like to thank the institution (Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University) for their contribution toward the statistical study design and study data analysis.

Funding

This study was supported by the Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province (Grant No. 2019GSZDSYS06), Gansu Province Science & Technology support program of Science and Technology department of Gansu Province (Grant No. 144FKCA073), and the Key Laboratory of Evidence-Based Medicine and Knowledge Translation Foundation of Gansu Province (Grant No. GSEBMKT-2021KFJJ001).

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  1. Caining Lei, Tingting Lu, and Wenwen Yang are co-first authors.

Authors and Affiliations

  1. The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, 730000, China

    Caining Lei & Tiankang Guo

  2. Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China

    Caining Lei, Wenwen Yang, Hongwei Tian, Shaoming Song, Shiyi Gong, Jia Yang & Tiankang Guo

  3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China

    Caining Lei, Tingting Lu & Kehu Yang

  4. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China

    Tingting Lu & Kehu Yang

  5. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, China

    Tingting Lu

  6. The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China

    Wenwen Yang & Shaoming Song

  7. The Affiliated Cancer Hosptial School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China

    Man Yang

  8. Key Laboratory of Surgical Tumor Molecular Diagnosis and Precision Therapy in Gansu Province, Lanzhou, 730000, China

    Hongwei Tian & Tiankang Guo

  9. Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, 730000, China

    Wenjie Jiang

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Contributions

TG, KY: conception and design of this work; CL, TL, and WY: acquisition and interpretation of data, drafting this work; CL, MY, HT, SS, SG, JY, and WJ revising it critically for important intellectual content. All authors approve the manuscript in its current form for publication and agree to be accountable for all aspects of the work.

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Correspondence to Kehu Yang or Tiankang Guo.

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Caining Lei, Tingting Lu, Wenwen Yang, Man Yang, Hongwei Tian, Shaoming Song, Shiyi Gong, Jia Yang, Wenjie Jiang, Kehu Yang, and Tiankang Guo have no conflicts of interest or financial ties to disclose.

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Lei, C., Lu, T., Yang, W. et al. Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis. Surg Endosc 35, 5918–5935 (2021). https://doi.org/10.1007/s00464-021-08648-y

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